2021.3.33.Grover_disease

Grover´s disease reaches 50 years

César Bimbi1, Antonio Carlos Bastos Gomes1, Piotr Brzezinski2, Daiane Flores Dalla Lana3

1Brazilian Society of Dermatology, Porto Alegre, Brazil, 2Department of Physiotherapy and Medical Emergency, Faculty of Health Sciences, Pomeranian Academy, Slupsk, Poland, 3Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Brazil

Corresponding author: Dr. César Bimbi


How to cite this article: Bimbi C, Bastos Gomes AC, Brzezinski P, Dalla Lana DF. Grover´s disease reaches 50 years. Our Dermatol Online. 2021;12(3):347-348.

Submission: 15.06.2020; Acceptance: 17.09.2020

DOI: 10.7241/ourd.20213.33

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© Our Dermatology Online 2021. No commercial re-use. See rights and permissions. Published by Our Dermatology Online.


Sir,

An otherwise healthy 58-year-old female presented herself with an acute-onset eruption of red excoriated papules located on the upper part of the back (Figs. 1a and 1b) and proximal sites of the upper and lower extremities, worsening during periods of hot or humid weather. The patient complained of severe itching.

Figure 1: (a and b) Red excoriated papules located on the upper part of the back.

The correlation of clinical features added to the histological pattern of focal acantholytic dyskeratosis (Fig. 2) led to a diagnosis of Grover’s disease (transient acantholytic dermatosis / TAD).

Figure 2: A biopsy showing focal acantholytic dyskeratosis, focal suprabasal acantholysis, and intense inflammatory infiltrate, composed mainly of lymphocytes, in the papillary dermis (H&E, 100×).

Systemic and topical steroids reduced the lesions and the patient was instructed to avoid such predisposing factors as heat, excessive sweating, and sun exposure.

Fifty years ago, Dr. Ralph Weir Grover, a NY dermatologist and dermatopathologist, uncovered the mystery of some unknown dermatologic cases hitherto regarded and diagnosed as atypical “Darier-like,” “pemphigus vulgaris-like,” and “Hailey–Hailey-like” disease most often affecting men over their fifties. These lesions occur due to the mechanism of separation of the skin’s outer layers of cells, a process known as acantholysis; this, however, happens with no clear cause. Since Dr. Ralph had always been attracted by cytology and had an in-depth knowledge and a special taste for anatomopathology, it was not difficult for him to detect a unique feature of focal acantholysis and dyskeratosis in those laminas. He termed his discovery as transient acantholytic dermatosis and published a manuscript in the April 1970 issue of Archives of Dermatology [1]. The condition was soon known as Grover’s disease (TAD) [2].

The origin of TAD is still unknown. What is known, however, is that that the proteins of the desmosomal attachment plaque are primarily affected, leading to desmosomal dissolution. More often than not, a history of atopic dermatitis, excessive sweating, and metal allergy is present. In our patient, irritative dermatitis and a very dry skin were noted. Since the disease is not rare, it might just be poorly diagnosed. Contrary to the term transient that forms part of the name, TAD is, in fact, chronic and some cases may last six to twelve months [3].

The purpose of reporting this case is to remind us of this poorly diagnosed pathology and also to pay tribute to Dr. Ralph, who passed away on May 25, 2008. As a sole practitioner, he uncovered the disease, making a dermatological history in a single-author manuscript, which has had a profound influence on the whole of the discipline.

To have been a solo practitioner of dermatology and to have identified a disease ‘‘missed’’ for centuries by ‘‘experts’’ in academe is no surprise to those who knew the brilliant turn of mind of Ralph. He was an original in every respect and a joy to work with. Not only did he have a marvelous, wry sense of humor, but he could be playfully puckish in selfdeprecation. As but one example, his middle name was ‘‘Wier,’’ about which he commented to me, ‘‘they left off the ‘d’!’’ It is regrettable that Ralph Wier Grover was not known personally to colleagues and trainees beyond Long Island. They would have reveled in his company and in his intellect, just as did I. ? A. Bernard Ackerman, M.D.

Whoever was lucky enough to be around him was brought to a higher level of understanding. And wherever he went he brought his humor and love. He will be missed and never forgotten, and all the people who learned from him will be carrying on his tradition of caring and joy. ? James M. Krivo, M.D.

According to those who knew and worked with Dr. Grover, he was an example to be secretly followed with great generosity toward those in pain. A professional with such sensitivity is instantly rewarded with gratitude and, then, an endless virtuous circle is established. The expression priceless seems to have been coined to define this magical situation. Doctors lacking in affection will also have their own patients brought by the system; however, they will never discover one of the wonders of the medical profession, that is, the infinite joy of being chosen by the patient as my doctor.

Consent

The examination of the patient was conducted according to the principles of the Declaration of Helsinki.

The authors certify that they have obtained all appropriate patient consent forms, in which the patients gave their consent for images and other clinical information to be included in the journal. The patients understand that their names and initials will not be published and due effort will be made to conceal their identity, but that anonymity cannot be guaranteed.

REFERENCES

1. Grover RW. Transient acantholytic dermatosis. Arch Dermatol. 1970;101:426-34.

2. Aljarbou OZ, Asgari M, Al-Saidi N, Silloca-Cabana EO, Alathamneh M, Sangueza OP. Grover disease with epidermal dysmaturation pattern:A common histopathologic finding. Am J Dermatopathol. 2018;40:642-6.

3. Al Aboud A, Al Aboud K. A mini-review on eponyms in the dermatology literature linked to United States of America (USA). Our Dermatol Online. 2013;4(Suppl. 1):409-13.

Notes

Source of Support: Nil,

Conflict of Interest: None declared.

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